Medicare fraud and scams: How to spot them and protect yourself

Medicare fraud vs. Medicare scams: What’s the difference?

Medicare fraud occurs when someone knowingly and incorrectly bills Medicare for services or supplies, to receive unauthorized benefits or payment.⁵ The majority of fraud activity is done by healthcare providers, medical suppliers, or insurance brokers, although enrollees may commit healthcare fraud in rare situations.⁷

Though these types of fraud are committed against the Medicare program itself, they can affect enrollees through unexpected bills and denied coverage.

Medicare scams, on the other hand, directly target Medicare beneficiaries. Scammers often pose as Medicare representatives, health plans, or healthcare workers to trick consumers into divulging their Medicare ID, Social Security number, or bank information.⁶

Once scammers obtain this information, they may file fraudulent claims in the beneficiary’s name, which can lead to identity theft, billing issues, and problems with Medicare coverage.⁸

What are the most common types of Medicare fraud?

While fraud schemes vary, they share a common goal: getting payments from Medicare by lying or overcharging. Common types of Medicare fraud include:^{5 9}

• Phantom billing: Medicare is charged for doctor visits, tests, or equipment that never took place or were never delivered.
• Upcoding: A provider charges for a more expensive procedure or service than what was rendered.
• Unbundling: Services that should be billed together at a lower cost are split into separate charges to increase payment.
• Double-billing: A service or supply is inappropriately billed to Medicare more than once.
• Unnecessary services: A provider performs and bills for tests, treatments, or supplies that aren’t medically needed.
• Kickbacks: Providers receive money or other incentives in exchange for referring patients for tests, treatments, or services.
• “Free” offers: Providers advertise “free” medical equipment or services to beneficiaries but bill Medicare without the beneficiary’s knowledge or consent.
• Medical identity theft: Someone uses another beneficiary’s Medicare number to receive care or bill services fraudulently.

What are the most common types of Medicare scams?

Medicare scams tend to follow a pattern: they create urgency, sound official, and pressure people to act quickly before there’s time to double-check the details. These schemes don’t come from Medicare itself. They come from criminals who are attempting to steal personal information or money.⁶

Below are some of the most common Medicare scams, how they work, and how to spot them:

Calls or messages asking to verify Medicare information

In this common scam, a Medicare beneficiary receives a call, text, or email claiming that Medicare needs to verify their identity to prevent the beneficiary’s benefits from being suspended or canceled.⁶ Scammers often use threatening language like “Your account has been flagged for suspicious activity” or “You’ll lose your coverage if you don’t act immediately.”⁶

Red flags to note:¹⁰

• Requests for Medicare or Social Security numbers
• Urgent deadlines or threats of coverage loss
• Claims that the caller is “from Medicare” without you contacting them first

Medicare and Social Security Administration representatives will never contact you to ask for your personal information, such as your Social Security, bank account, or your Medicare identification number.¹¹

But if you call Medicare or the Social Security Administration and ask the representative to access your account, you’ll be asked for your Medicare or Social Security number.¹¹ In this case, you’ve initiated the call yourself to these official entities, so you can feel confident providing the information they request.

Beware of spoofing, a technology scammers often use to manipulate caller ID information to make a call look like it’s coming from a government agency or a familiar healthcare provider.⁶ If you receive an unexpected call asking for personal information, hang up. After hanging up, you can always call Medicare directly at 1-800-MEDICARE (1-800-633-4227) to verify whether a call is legitimate.

Open enrollment plan-switching scams

Scammers often take advantage of the Medicare Open Enrollment period to pose as insurance agents or plan representatives. They often use high-pressure tactics, claiming a beneficiary’s current plan is being discontinued or that they need to switch immediately to avoid losing coverage.⁶

Scammers may also promise benefits that don’t exist or misrepresent what a plan covers. Their goal is to earn a commission from enrolling you in a new plan without clear consent.

Red flags to note:¹²

• Unsolicited calls pressuring you to switch plans
• Claims that your current plan is ending when you haven’t received official written notice from your plan
• Promises of benefits that sound too good to be true
• Requests for your Medicare number to check your eligibility before explaining plan details

Legitimate Medicare plans do not pressure people into immediate decisions or request sensitive information during unexpected calls.¹³ In fact, Medicare Advantage plans are not allowed to make unsolicited phone calls to prospective members. They can only call if you’re already enrolled, requested contact, or called them first.¹³ If your plan is ending or changing, you’ll receive official written notice from your current plan or Medicare. Licensed agents can help you compare plans, but you should never feel rushed into switching.

Free medical equipment scams

Another common scam involves offers for “free” medical equipment, such as back braces, orthotics, or urinary catheters, with scammers claiming Medicare approved the item or that a healthcare provider recommended it.¹⁴ They’ll generally ask for your Medicare number, then turn around and bill Medicare for equipment that was never needed, approved, or delivered.¹⁵

Red flags to note:¹⁵

• Unsolicited calls, texts, or door-to-door visits offering “free” equipment
• Claims that equipment is “completely covered by Medicare” without a doctor’s order
• Pressure to provide your Medicare number immediately to verify eligibility
• Equipment arrives that you didn’t request

Medicare covers durable medical equipment only when it’s medically necessary and ordered by your doctor.¹⁶ If you didn’t discuss it with your healthcare provider, it’s a scam.

Free genetic or at-home testing scams

You might receive phone calls, mailers, or ads promoting “free” genetic tests or at-home testing kits for cancer screening, dementia detection, heart disease, or medication metabolism testing.¹⁷ Some scammers set up booths at community events, health fairs, or senior centers, offering free cheek swab tests.¹⁸ Once they obtain your Medicare number, they bill Medicare thousands of dollars for tests that weren’t medically necessary or ordered by your doctor.¹⁸

Red flags to note:¹⁸

• Offers for “free” genetic or cardiovascular testing without your doctor’s order
• Genetic testing offered at health fairs, senior centers, parking lots, or through unsolicited calls where you’re requested to provide your Medicare information
• Use of telemedicine where a healthcare provider you’ve never met orders the test
• Testing kits arrive that you didn’t request
• Charges on your Medicare Summary Notice (MSN) for Original Medicare beneficiaries, or explanation of benefits (EOB) for Medicare Advantage enrollees, for expensive genetic tests you don’t remember receiving

Medicare covers genetic testing for certain cancer risks or to determine how a person may respond to medications, but only when medically necessary and ordered by a qualified healthcare professional.^{19 20} Legitimate genetic tests aren’t offered for free at public events or through random phone calls.

Medicare data breach scams

When a real data breach affecting Medicare beneficiaries is announced in the news, scammers jump on the opportunity to get the information. They contact people claiming to be from Medicare or a related agency, saying they need to verify information or issue new identification numbers due to the breach.²¹ These scams resurface every time a healthcare data breach makes headlines.

Red flags to note:²¹

• Calls or texts referencing a recent data breach you heard about in the news
• Claims you need to “protect your account” or “verify your information” immediately
• Requests for your Medicare number, Social Security number, or bank information
• Pressure to act quickly to get a new card or avoid losing coverage

If a data breach affects your Medicare information, the Centers for Medicare & Medicaid Services will mail you a letter. The letter will explain what happened, what information was compromised, and steps you should take, if any.²² Medicare will never contact you by phone, email, or text to ask for your personal information or tell you to get a new card due to a breach.

I gave my Medicare number to a scammer, now what?

If you shared your Medicare number and later felt there was something suspicious about your interaction, it’s understandable to feel worried and upset, but taking action quickly can help mitigate the damage and protect your benefits. Here’s what to do:²³

• Call Medicare immediately at 1-800-MEDICARE (1-800-633-4227). Let them know your Medicare number may have been compromised. They can flag your account and give you guidance on the next steps.
• Carefully review your Medicare Summary Notice (or explanation of benefits, if you’re on Medicare Advantage). Check for charges for services, tests, or equipment that don’t look familiar or were never received.²⁴
• Report any suspicious charges. Contact Medicare right away to notify them of any unfamiliar charges so they can investigate and stop future payments.
• Request a new Medicare card if needed. If you believe your Medicare number is being misused, you can request a replacement card through your gov account or by calling Medicare.¹¹
• Place a fraud alert with the credit bureaus if your Social Security number was also compromised. Contact Equifax, Experian, and TransUnion to add a fraud alert to your credit report.²⁵ Also, report the crime to the Federal Trade Commission online at gov or by calling 1-877-IDTHEFT (1-877-438-4338).
• Report the scam to the Office of Inspector General (OIG). Call the fraud hotline at 1-800-HHS-TIPS (1-800-447-8477) or file a report online.

How can I protect myself from Medicare fraud and scams?

The best way to avoid becoming a victim is to stay alert to red flags and guard your information. Consider the following steps:²⁶

• Treat your Medicare number like a credit card. Never share your Medicare or Social Security number with anyone who contacts you unexpectedly. Your Medicare information should only be shared directly with your healthcare provider’s office or during calls and appointments you schedule. Any other request should raise concern.
• Hang up on unexpected calls that ask for personal information. If the call claims to be from Medicare, Social Security, or a health plan, call back using the entity’s official phone number. Scammers can make a call appear to come from an official agency, clinic, or plan, so don’t trust caller ID alone. If something feels off about the call, trust your instincts and hang up.
• Review claims regularly. Check the Medicare Summary Notice (for Original Medicare) or Explanation of Benefits (for Medicare Advantage and Part D plans). Report any charges that do not make sense.
• Track your care. Keep a list of appointments, tests, and equipment received so it is easier to identify false claims.
• Use a Medicare account to monitor activity. Set up access at gov to view claims and catch issues sooner.
• Don’t click on links in suspicious emails or text messages. Scammers create fake emails and texts that appear to come from Medicare. Never click links or open attachments from unsolicited messages. If you need to access your Medicare account, type Medicare.gov directly into your browser.
• Stay informed about current scams. Monitor consumer alerts from the Office of Inspector General to learn about the latest fraud schemes targeting Medicare beneficiaries.²⁷
• Add your phone number to the National Do Not Call Registry. Register at gov or call 1-888-382-1222. While this won’t stop all unwanted calls, it can reduce them.
• Be extra cautious during Medicare Open Enrollment. Scam activity increases during this period, so only work with licensed insurance agents you have contacted yourself.
• Know how Medicare communicates. Medicare primarily sends information by mail. They won’t call you to ask for personal information unless you contacted them first, and they won’t threaten to cancel your coverage.
• Shred documents with personal information. Before throwing away documents that contain personally identifiable information (PII) or protected health information (PHI), shred them.
• Limit what gets shared publicly. Avoid posting birthdate, address, or insurance details on social media. Scammers can use these small details to sound convincing.
• Be skeptical of too good to be true offers. Free equipment or promises of extra benefits in exchange for your Medicare number are red flags.